Chiropractic & Osteopathy explores use of chiropractic for children

by Terry A. Rondberg, DC, founder and CEO of the World Chiropractic Alliance

A series of articles on the theme of chiropractic and children, published in June by the journal Chiropractic & Osteopathy, address a chiropractic approach to the management of children, chiropractic care of musculoskeletal conditions in children and adolescents, chiropractic care of non-musculoskeletal conditions in children and adolescents, chiropractic care for attention-deficit/hyperactivity disorder, possible adverse effects from chiropractic management of children, and an overview of future research opportunities in this area.

An editorial in the series, titled, "Chiropractic care for children: too much, too little or not enough?" by Drs. Simon French, Bruce Walker, and Stephen Perle, paints the most discouraging picture. The authors reiterate the often-stated need for additional research, noting: "As consistently demonstrated in the review articles in this Thematic Series, effective chiropractic management of children is not supported by strong evidence, but chiropractic care for children seems to carry a very low risk of adverse events."

Given this lack of research evidence, the authors ask: "Should chiropractors be accepting and treating children considering the scarce evidence available? Are chiropractors qualified to diagnose and treat children who present for their care? Should chiropractors charge money for treatment that does not have evidence to support that it is effective?"

Researchers from the Nordic Institute of Chiropractic and Clinical Biomechanics in Denmark were less diplomatic. In their paper, "The evidence base for chiropractic treatment of musculoskeletal conditions in children and adolescents: The emperor's new suit?" authors Lise Hestbaek and Mette Jensen Stochkendahl explained that what first appeared to be a large body of literature in relation to chiropractic treatment of children turned out to be "a case of the emperor's new suit. Of the almost 500 identified titles, there were several hundred case studies, reviews, letters etc., but only four clinical studies related to the effect of manual therapy on musculoskeletal problems in children, one of which was a pilot study and two lacked a control group. It is long overdue that we, as caretakers of musculoskeletal health, face reality…. we must stop making reviews and recommendations based upon hot air and instead start creating a proper robe for the emperor. He needs it."

Other papers gave at least some weight to clinical experience and anecdotal evidence. The article "Chiropractic approach to the management of children," notes: "Often, as demonstrated anecdotally in the academic clinical setting or over the years at facilities like Kentuckiana Children's Center … when chiropractic treatment is provided in collaboration with other healthcare professionals (nutritionists, occupational therapists, physical therapists, art and recreational therapists, etc.), many children demonstrate improved development or a more consistent maintenance of their quality of life."

Drs. Randy Ferrance and Joyce Miller came to a similar conclusion after reviewing the literature relating to "Chiropractic diagnosis and management of non-musculoskeletal conditions in children and adolescents," which was the title of their paper. "The efficacy of chiropractic care in the treatment of non-musculoskeletal disorders has yet to be definitely proven or disproven, with the burden of proof still resting upon the chiropractic profession," they stated. They reviewed evidence on chiropractic's use in cases of colic, enuresis, asthma, otitis media, and attention deficit hyperactivity disorder.

One of the more provocative papers was the commentary by Charlotte Leboeuf-Yde and Lise Hestbæk, titled "Chiropractic and children: Is more research enough?" In it, they, too, lamented the lack of hard research and even suggested that we need fewer case studies and, instead, need to focus on "epidemiologic studies, various registers, in everyday practice and through laboratory experiments. Data can also be collected by asking questions, observing, and using advanced technology. Importantly," they asserted, "the research design should match the research question and the conclusion should not exceed the result."

Their conclusion, however, was heartening: "Over the past years there has been some controversy about whether chiropractors can treat children or not. The question appears nonsensical. Why should chiropractors not be able to treat children? Obviously the scope of complaints will differ somewhat for different age groups, and the management strategy including choice of treatment methods will have to be adapted to the individual, but this is not specific to children. This argument seems to be supported by the fact that when children are treated by chiropractors the way adults are treated in chiropractic practice (i.e. mainly for musculoskeletal disorders and for the occasional 'other' condition), no such controversy appears to exist."

"This is a valuable and interesting series of articles," commented Terry A. Rondberg, DC, founder and CEO of the World Chiropractic Alliance and publisher of The Chiropractic Journal. "While I wish it had focused more on the neurological impact of chiropractic adjustments, and less on musculoskeletal conditions, it did a good job of repeating what we have been saying for years -- that we need more substantive research on the impact of chiropractic on all aspects of health, for adults as well as children."

Dr. Rondberg also pointed to the fact that the entire series was devoid of any discussion of subluxation. "Obviously, there are still some publications and segments of the chiropractic profession that want to distance us from the notion of subluxation completely. While that is one possible approach, I hope to see additional articles exploring new research and concepts regarding the neurological and musculoskeletal components of subluxation."

The entire series is available online

(Dr. Terry A. Rondberg is founder and CEO of the World Chiropractic Alliance and publisher of The Chiropractic Journal. His reports on other health and wellness news appear on www.terryarondberg.com, www.terryrondberg.com.)